Thursday, April 17, 2014
The Associated Press
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In this April 15, 2013 photo, an injured person is helped on the sidewalk near the Boston Marathon finish line following an explosion in Boston. The bombs that made Boston look like a combat zone have also brought battlefield medicine to their civilian victims. A decade of wars in Iraq and Afghanistan has sharpened skills and scalpels, leading to dramatic advances that are now being used to treat the 13 amputees and nearly a dozen other patients still fighting to keep damaged limbs. (AP Photo/MetroWest Daily News, Ken McGagh, File)
In this Monday, May 28, 2012 file photo, U.S. Army Capt. Dan Berschinski, foreground, uses prosthetic legs to stand on the field before a baseball game between the St. Louis Cardinals and Atlanta Braves in Atlanta. Nearly 2,000 American troops have lost a leg, arm, foot or hand in Iraq or Afghanistan, and their sacrifices have led to advances in the immediate and long-term care of survivors, as well in the quality of prosthetics that are now so good that surgeons often chose them over trying to save a badly mangled leg. (AP Photo/David Goldman)
FOR MORE INFORMATION, visit our special section covering the Boston bombings.
"We improved our plans for triage, site security, reassessment and inter-specialty coordination" following Halpern's visit, Biddinger said.
Blast victims can be challenging to treat because they typically have multiple complex physical injuries that may include loss of limbs, fractures, brain damage, and vision and hearing impairment, said Dr. Paul Pasquina, chairman of physical medicine and rehabilitation at the Uniformed Services University and Walter Reed National Military Medical Center.
"It's very important that during their acute medical and surgical care that rehabilitation is applied early on, to get them up as soon as possible" to reduce risks from being immobile, including blood clots, deconditioned muscles and other problems that will make recovery more difficult," he said.
A multidisciplinary approach that involves everyone from plastic and orthopedic surgeons to therapists is important, said Dr. James Ficke, chairman of the department of orthopedics and rehabilitation at San Antonio Military Medical Center. He also advises the U.S. Army Surgeon General on orthopedics.
"The lessons we've learned are early surgery, multiple surgeries and getting them back to skilled facilities in a fairly fast fashion," he said.
"As a doctor, one of the lessons I learned most dramatically is I don't have any preconceptions of what they can or can't do as a patient. There was a patient who lost his leg completely and had no hip joint and recently did a marathon in Austin in 4:33."
For some, that may mean a prosthetic leg. John Fergason, chief prosthetist at Center for the Intrepid, the outpatient rehab center at the San Antonio medical center.
Brooke Army Medical Center, said there have been many advances, including computerized knees that allow amputees with above-the-knee amputations to walk down steep ramps, to walk up steps and go from a walk to a run.
After every war, "you see a tremendous spike in prosthetic innovation," largely because of increased research money, said Hugh Herr, a prosthetic expert at MIT and a double-amputee himself. Federal funds let his MIT lab do basic research on a bionic foot-ankle-calf system, and he founded a company that has commercialized that device.
If Boston victims are generally healthy and motivated, and their legs are amputated below the knees, or perhaps even above the knees, "it's possible they could run the marathon a year from now," he said. "It would take a lot of effort, but it's indeed possible with today's technology."
One amputee's story is encouraging.
Dan Berschinski, 28, used to run marathons but now works with the Amputee Coalition, an advocacy and support organization based in suburban Washington, D.C. He was an infantry officer in Afghanistan when he stepped on an IED in August 2009. The blast blew off his entire right leg and most of his left leg. After treatment in the field and in Germany, he was sent to Walter Reed.
His biggest initial challenge was intense pain, treated with narcotic painkillers, and phantom leg and foot pain. Doctors used to consider phantom pain a psychological problem but now consider it real, physical pain. Treatment includes nerve blockers.
"If they hit you really hard with a combination of narcotics and nerve drugs, people have a lower incidence of phantom pain the rest of their life," Berschinski said.
Recovery and rehab took about three years, including 10 months of daily physical therapy to strengthen his arms and core — muscle power he'd need to learn to walk on prosthetics.
The bionic legs he uses cost $60,000 a piece, are hydraulically operated and equipped with microchips and a gyroscope that sense when to relax and stiffen to help him walk. Walter Reed was involved in developing the legs, said Zach Harvey, former prosthetics chief at Walter Reed.
Berschinski used to run marathons but now can go only about half a mile. He competes in triathlons — swimming, biking with his arms, and racing in a wheelchair, and sometimes plays wheelchair basketball.
"I'm very happy with my progress," he said.
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In this Thursday, Oct. 4, 2012 file photo, U.S. Marine Cpl. Daniel Riley, 21, navigates the steps outside his apartment on his prosthetic legs in San Diego, Calif. Riley lost both legs to an IED in Afhganistan. Nearly 2,000 American troops have lost a leg, arm, foot or hand in Iraq or Afghanistan, and their sacrifices have led to advances in the immediate and long-term care of survivors, as well in the quality of prosthetics that are now so good that surgeons often chose them over trying to save a badly mangled leg. (AP Photo/Lenny Ignelzi)